Surgical reconstruction of hard tissue, such as the placement of prosthetics, the repositioning and attachment of fractured bones and the addition of metallic support plates to repaired bone typically require the placement of fasteners, which may be adhesives, mechanical devices, or combinations thereof. In many instances the fastening system includes screws, which may have special thread and head designs adapted for the particular application or the placement system. These screws are often very small in size and therefore difficult to handle, position and thread into the underlying structure and can easily be dropped into the surgical cavity if they are being manually manipulated.
Systems comprise manual screw drivers or, more recently, cordless, battery powered drivers, to transmit a rotational driving force to screws, which may have specialized heads to match the driver tips. Because a typical procedure may require placement of numerous screws (20-60) the powered drivers are now preferred. A typical power driver is a reusable pencil grip instrument with a replaceable, single use, sterile, disposable battery pack. However, hospital personnel must still perform the tedious task of attaching each screw to the tip of the screwdriver or into a retaining structure on the tip and then handing it to the surgeon or manually loading a feeding system adapted to place the screw in front of the driver tip. The screw head has a recessed structure, such as a slot or a recessed geometric structure for example, cruciform, Phillips, square, hexagonal or exalobe shaped holes, for torque transmission from a matching structure on the tip of the driver. For torque transmission and to limit the tip from disengaging from the structure in the screw head the tolerances of the fit between the tip and the screw head construction are minitnal and in some instances tapered to provide secure engagement (U.S. Pat. No. 4,269,246 to Larson et al.)
There are numerous publications and patents which show devices that relate to the field of the invention. They are directed to the placement of, or automatic delivery of, fasteners to a particular location and systems for driving the fasteners. The following are merely representative of the art; there are others which are primarily repetitive of those discussed herein. Many are for industrial applications and can not meet the needs of a surgeon for use in an enclosed, sterile environment and do not lend themselves to automatic one hand operation. Systems for delivering a fastener to the operative, rotating tip of a screw driver include:    a) Non-Banded Delivery—U.S. Pat. No. 3,946,926 to Willis is an example of a pneumatic or strictly mechanical delivery of fasteners from a hopper. U.S. Pat. No. 4,408,877 to Lindmo et al. appears to cover loose screws fed along a track disposed in front of the screwdriver tip.    b) Stacked Fasteners—U.S. Pat. No. 5,590,574 to Lide is an example of a system that provides a linear arrangement of fasteners stacked head to tail inside the screwdriver.    c) Vertical Band—There are numerous patents to systems in which the fastener (nail or screw) lies across the face of a band and are attached to the band by notches or loops extending from the surface of the band. Alternatively the band may have a thickness so that the fastener can be inserted in a hole which extends through the band from one edge to a parallel opposite edge, for example, U.S. Pat. Nos. 5,758,768, 5,622,024, 5,469,767, and 4,930,630 to Habermehl as well as numerous other Habermehl patents. However, they all appear to use a band which attaches to the side of the fastener and which places the band in a plane coextensive with the axis of the screwdriver.    d) Horizontal Band—There are numerous patents that are directed to systems in which the screw is placed through a hole in the surface of the band with the band resting somewhere along the length of the shank of the screw or just below the head of the screw. These include US Patents to Chen (U.S. Pat. No. 5,522,687), Dohi (U.S. Pat. No. 5,544,746), Hon (U.S. Pat. No. 5,509,768), Huang (U.S. Pat. Nos. 5,931,298, 5,803,691, 5,788,445, 5,779,420), Lejdegard (U.S. Pat. No. 4,018,334), Lin (U.S. Pat. No. 5,775,514), and Shinjo (U.S. Pat. Nos. 5,984,096 and 6,761,268) all of which show various band designs which include extensions created from or formed below the surface of the band designed to grip the shaft of the screw.
Other patents are directed to the surgical fasteners and the design of the head of the fastener and drivers constructed to work with these fasteners or hold the fastener during the placement procedure. None of these patents include automatic delivery of the fasteners.
These prior devices do not provide the ease of operation and the ability to continuously and rapidly place numerous screws into the bone structure while minimizing the risk of loss of the screws during the procedure and the amount of time necessary to prepare the tool and the fasteners for use in the surgical procedure. These deficiencies were addressed in applicant's U.S. Pat. No. 7,406,899, incorporated herein in its entirety by reference.